Alveolar echinococcosis (AE) is a chronic disease caused by ingestion of the eggs of the parasitic cestode Echinococcosis multilocularis (EM). In severe cases, liver transplantation (LT) may represent the only possibility of survival and cure. Patients undergoing LT associated with hepatic AE at our institution between April 2011 and October 2014 were investigated retrospectively. The clinical findings of the 27 patients who participated in the study were noted. Kaplan-Meier and chi-square tests were used to investigate the effect of these characteristics on survival and mortality. Living donor LT was performed on 20 patients (74.1%), and deceased donor LT was performed on 7 patients (25.9%). Hilar invasion was the most common indication (14 patients, 51.9%) for transplantation. The patient follow-up was 16.1 6 11.4 months, and the overall survival rate was 77.8%. Primary nonfunction developed only in 2 patients in the posttransplantation period. Six patients died during monitoring, the most common cause of death being sepsis (3 patients). The relationship between the mortality rate of the patients and the invasion of the bile duct and/or portal vein by alveolar lesions was found to be statistically significant (P 5 0.024 and P 5 0.043, respectively). According to PNM staging, when the AE disease exceeds the resectability limits, the only alternative for the treatment of the disease is LT. However, different from LT due to cirrhosis, it is extremely difficult to perform a transplantation for AE disease because of the invasive characteristics of it. In order to decrease the difficulty of the operation and the postoperative mortality, the intracystic abscess and cholangitis which occur because of AE must be treated via medical and percutaneous methods before transplantation.

Objective: The aim of this study was to analyze the temporal trends of HIV epidemiology in Turkey from 2011 to 2016. Method: Thirty-four teams from 28 centers at 17 different cities participated in this retrospective study. Participating centers were asked to complete a structured form containing questions about epidemiologic, demographic and clinical characteristics of patients presented with new HIV diagnosis between 2011 and 2016. Demographic data from all centers (complete or partial) were included in the analyses. For the cascade of care analysis, 15 centers that provided full data from 2011 to 2016 were included. Overall and annual distributions of the data were calculated as percentages and Chi square test was used to determine temporal changes. Results: A total of 2,953 patients between 2011 and 2016 were included. Overall male to female ratio was 5:1 with a significant increase in the number of male cases from 2011 to 2016 (p<0.001). The highest prevalence was among those aged 25-34 years followed by the 35-44 age bracket. Most common reason for HIV testing was illness (35%). While the frequency of sex among men who have sex with men increased from 16% to 30.6% (p<0.001) over the study period, heterosexual intercourse (53%) was found to be the most common transmission route. Overall, 29% of the cases presented with a CD4 count of >500 cells/mm3 while 46.7% presented with CD4 T cell count of <350 cells/mm3 . Among newly diagnosed cases, 79% were retained in care, and all such cases initiated ART with 73% achieving viral suppression after six months of antiretroviral therapy. Conclusion: The epidemiologic profile of HIV infected individuals is changing rapidly in Turkey with an increasing trend in the number of newly diagnosed people disclosing themselves as MSM. New diagnoses were mostly at young age. Late diagnosis was found to be challenging issue. Despite unavailability of data for the first 90, Turkey is close to the last two steps of 90-90-90 targets.

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Although increased serum levels of IL-18 were not specific for TB, the increased levels may favour active TB in radiologically advanced disease where CXR findings are difficult to interpret, and sputum smears or cultures are not helpful.

Objective: Hepatitis delta virus (HDV) is the smallest known virus to infect humans. HDV, a defective ribonucleic acid (RNA) virus, is also the most important cause of liver-related mortality in patients with hepatitis B. Fifteen-20 million people worldwide are estimated to be infected with HDV. In this study, we aimed to determine the epidemiological and clinical manifestations of HDV infection and to asses the data on clinical and laboratory findings, treatments, serologies and biopsy results in patients with HDV infection. Materials and Methods: The records of patients with HDV infection who attended the infectious diseases and clinical microbiology clinics at Atatürk University Medical Faculty Hospital between 2008 and 2013 were retrospectively analyzed. Antigen and antibody results were investigated using enzyme-linked immunosorbent assay (ELISA) (Dia. Pro Diagnostic Bioprobes Srl, Milan, Italy). Determination of hepatitis B virus (HBV) DNA values and HDV RNA (Qiagen © , Germany) was performed using real-time polymerase chain reaction. Liver biopsies were performed and the specimens were assessed using Knodell's scoring system. Results: Two thousand five hundred forty hepatitis B surface antigen (HBsAg)-positive patients were included in the study. One hundred and three (4.05%) patients (35 female-34%-and 68 male-66%-) aged between 19 and 70 years (median: 49 years) were HDV antibody (anti HDV)-positive. Cirrhosis developed in 10 (9.7%) patients. Sixty (58.3%) patients were anti HBe-positive, while 34 (33%) were hepatitis B e antigen (HBeAg) and anti-hepatitis B e (anti-HBe) negative. Conclusion: HDV should be investigated in patients with hepatitis B due to its association with the increased risk of progression to liver cirrhosis (LC) and hepatocellular carcinoma, as well as mortality rates. Hepatitis D is still a significant problem in Turkey and especially in our region. Nationwide hepatitis B vaccination programs and frequent screening of blood specimens will prevent hepatitis D.

chinococcosis is an infection with the canine tapeworm Echinococcus granulosus (E. granulosus) and is associated with various sheep-and cattleraising areas of the world. 1 Typically in humans, cysts form in the liver (60% of cases) and lung (20-30% of cases; more common in children). 2 Although most often found in the liver and lung, hydatid cysts can occur in any organ or tissue and if ruptured, there is dissemination of scolices (an immature stage) via the blood stream. Cardiac involvement of echinococcosis is rare, and occurs in approximately 2% of all patients, typically localized to the left or right ventricle. [2][3][4] Although cardiac echinococcosis is rare, localization to the myocardium may lead to life-threatening complications, including cyst rupture, anaphylactic shock, tamponade, pulmonary, intracerebral or peripheral arterial embolism, acute coronary syndrome, arrhythmias and infection, any of which require aggressive treatment. 4 We present a rare case of recurrent intramyocardialextracardiac hydatid cyst with pericardial protrusion that was surgically removed. Case ReportA 26-year-old man was admitted with chest pain and palpitations, which had started approximately 6 months before admission. He had undergone surgical resection 10 years earlier of an intramyocardial hydatid cyst without cardiopulmonary bypass. Physical examination did not reveal any abnormal findings: his lungs were normal on auscultation, no cardiac murmur or gallop rhythm was noted, and biochemical laboratory test results were within normal limits. Myocardial-specific enzyme values were within the normal range.The patient's chest X-ray was normal, except for the sternal suture, and the ECG showed normal sinus rhythm with T-wave inversion in leads V1-6, consistent with ischemia. Apical 2-chamber transthoracic echocardiography showed a multivesicular cystic mass on the left lateral ventricular wall in the pericardial sac. The cyst, measuring 6×4×5 cm, was localized to the inferoposterior wall of the left ventricle and protruded toward the pericardium ( Fig 1A); this finding was confirmed by transesophageal echocardiography (TEE). We did not detect any additional visceral localization of the cyst on abdominal ultrasonography. The patient was examined further by multislice computed tomography (CT) of the chest in order to determine the exact location, size and number of disseminated hydatid cysts; a 5.7×4.8 cm round cystic mass with well-defined contours was located next to the left ventricle (Fig 1B). The cyst had a germinative membrane that did not allow communication between the mass and the cardiac chambers or extrinsic structures. Additionally, in view of the clinical suspicion of coronary artery disease, coronary angiography was performed, and was determined to be normal.Because of the previous history of hydatidosis, serologic tests (indirect hemagglutination tests) were performed. The results were positive for E. granulosus, and there was an accompanying eosinophilia. Because the clinical, radiologic, and serologic finding...